Healthcare Provider Details

I. General information

NPI: 1396847612
Provider Name (Legal Business Name): JERRY RANGEL LMSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 HORIZON HILL BLVD
SAN ANTONIO TX
78229-2258
US

IV. Provider business mailing address

6003 CLEARBROOK ST.
SAN ANTONIO TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-321-2714
  • Fax: 210-321-2728
Mailing address:
  • Phone: 210-521-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: